ENCEFALITIS AUTOINMUNE MEDIADA POR ANTICUERPOS CONTRA EL RECEPTOR N-METIL-D-ASPARTATO: REPORTE DE CUATRO CASOS EN PERÚ.

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an anti-neuronal antibody-mediated inflammatory brain disease whose early diagnosis and treatment significantly improves the disease prognosis. We report four cases with definitive diagnosis of anti-NMDAR encephalitis hospitalized at Instituto Nacional de Ciencias Neurológicas, Lima-Perú. All patients had seizures, being refractory status epilepticus observed in three cases (75%). Psychiatric disorders, dyskinesia and dysautonomic signs were evidenced in all patients, and two of them required mechanical ventilation. Electroencephalographic abnormalities were reported in all patients; as well as abnormal cytological findings in cerebrospinal fluid in two (50%), and brain lesions in magnetic resonance imaging in one (25%). All patients were treated immunosuppressive medication with methylprednisolone, and two of them (50%) required plasma exchange given the poor response to corticoids. At 12 months of follow-up after discharge, three patients (75%) did not report seizures and one of them did not achieve functional independence. Anti-NMDAR encephalitis mainly affects young people and we have to take it into account in our differential diagnoses given that its omission can lead to death or severe disability of our patients. Early diagnosis and treatment is essential for a positive prognosis. [ABSTRACT FROM AUTHOR]